Pilot & Feasibility Awardees
Strengthening and Supporting the Role of Primary Healthcare Providers in Diabetes Early Prevention Efforts
Jean Welsh, PhD, MPH, RN, Principal Investigator
The results of this pilot study will inform the design and implementation of a larger, randomized control trial (RCT). The goal of the RCT will be to test the impact of a multicomponent intervention to strengthen the early feeding improvement and diabetes prevention-related education and counseling provided by pediatric primary care providers and, thereby, increase parent compliance with sugar-containing beverage- (SCB) related feeding recommendations, decrease infant SCB consumption, and ultimately, lower their risk of developing diabetes.
Reducing inter-county disparities in diabetes outcomes through social-ecological interventions in Georgia
Shivani A. Patel, PhD, MPH, Principal Investigator
The investigators propose to stimulate diabetes translation interventions across multiple dimensions and levels following the social-ecological paradigm through: (a) enhancing institutional enrichment activities to include social-ecological perspectives; (b) announcing a call for pilot proposals that focus on multi-level interventions; (c) developing a community-academic network. The Design and Evaluation Core, Engagement and Behavior Change Core, and Disparities Core propose to collaboratively engage in activities to lay the foundation for initiatives a-c. The investigators ultimately seek to build towards designing a multi-level intervention package that can be tested in a future translation trial engaging our community-academic network partners.
Impact of COVID-19 on African American Adults with Diabetes and Heart Failure
Rakale C. Quarells, PhD, Principal Investigator
The goals of the proposed study are to explore the context which COVID-19 may contribute to suboptimal health outcomes within the African American community. Specifically, the investigators will seek to gain a better understanding of perceptions of the impact of COVID-19 on access to care, diabetes and heart failure (HF) management, social isolation, loneliness, and depression, as well as COVID-19 vulnerability among African Americans with diabetes and HF. By exploring these perceptions, they will be able to determine the best strategies for addressing the health of a high-risk vulnerable population with the comorbid conditions of diabetes and HF.
Exploring The Preparedness Cycle in the Care of People During the COVID-19 Pandemic and Future Outbreaks.
Francisco J. Pasquel, MD, MPH, Principal Investigator
A large proportion of patients with COVID-19 have diabetes, which has been recognized as a common comorbidity among those with severe disease. The investigators aim to evaluate components of the Preparedness Cycle framework (utilized in emergency/disasters) to immediately respond to this public health crisis and mitigate potential harms related to practice change or clinical inertia associated with fear and a lack of PPE. They will also assess failures and challenges in the care of patients with diabetes in the time surrounding this pandemic and design a plan to follow patients after the crisis in preparation for similar situations in the future
Estimating Avoidable Acute Complications and Outcomes in Adults with Diabetes and End-Stage Renal Disease
Rodolfo J. Galindo, MD, Principal Investigator
The investigators propose to use the most comprehensive database of patients with chronic kidney disease, the United States Renal Data System (USRDS) to estimate the avoidable complications of DM in end-stage renal disease (ESRD) patients, and particularly among minorities and different age groups.
The investigators will identify a contemporaneous matched control group using de-identified electronic medical records. Controls will be matched on timing of care, clinic site, age, gender, health status and health care utilization. They will use generalized estimating equations to compare changes in BMI, blood pressure and hemoglobin A1C over time between intervention and controls. Findings will be used to develop an application for diabetes translation research that will utilize a multi-phase optimization strategy trial (MOST) approach to refine the [Grady Fruit and Vegetable Prescription Program] intervention package and test the effectiveness and cost-effectiveness of the refined package on diabetes related health outcomes using a randomized controlled design.
American Sign Language-Accessible Diabetes Education (ASL-ADE)
Salimah LaForce, MS, Principal Investigator
ASL-ADE will conduct an efficacy study, in the Engagement and Behavior Change Core, with the long-term objective of improved health outcomes for individuals who are Deaf and primarily communicate using ASL. The project will demonstrate the need for diabetes educational materials to be accessible to people who are Deaf and rely on ASL for clear and effective communications.
The goal of this project is to conduct a pilot study to determine the feasibility of delivering a mindfulness-based stress reduction (MBSR) plus sleep education intervention to improve sleep and subsequently improve subclinical biomarkers of T2DM risk among a community sample of racially diverse adults (N=20) with poor sleep quality and pre-diabetes.
Characterizing Diabetes Screening Systems for Design, Evaluation and Disparity Identification
Douglas Bodner, PhD, PE Principal Investigator
This project proposes to model gaps in delivery in order to suggest improvements to configure resource allocation so that needed treatments are in fact available across socio-demographic subgroups and the socioeconomic spectrum. It will use agent-based simulation, which facilitates modeling of care system elements and their extensive interactions, all of which affect overall care system performance.
A Field Trial of the Guide to Goals Application - a Care Coordination Tool to Translate ADA Clinical Standards of Care for Children with T2D into Practice
Jiten Chhabra, MBBS, MS, Principal Investigator
The ultimate goal of this project is to systematically evaluate a novel care coordination tool for children with Type 2 Diabetes (T2D) in an office setting at Emory/Children’s Healthcare of Atlanta. The Guide to Goals (GTG) application was designed and developed at Georgia Institute of Technology with the aim of providing evidence-based information in a timely manner to all the stakeholders involved in the care of a diabetes patient during an office visit.
Culturally Tailored - Cognitive Behavioral Intervention (CT-CB) for African American patients with Type-2 Diabetes A Pilot Study
Ambar Kulshreshtha, MD, PhD, FAHA, Principal Investigator
There is scarce data regarding the effectiveness of adapted and tailored cognitive-behavior change interventions and delivery in innovative low-cost formats for vulnerable population subgroups. The aim of this study is to test the feasibility and acceptability of a Culturally-Tailored, Cognitive Behavioral intervention (CT-CB) program (in group-based and phone-based formats), compared with usual care, and to determine if the intervention can improve diabetes self-management among African American patients. The study will also seek to determine whether a particular subset of patients is more likely to experience improvements.
Feasibility of a Soccer-based Adaptation of the Diabetes Prevention Program
Jennifer Frediani, PhD, RD, Principal Investigator
Hispanic males are difficult to engage in traditional lifestyle or non-communicable chronic disease (NCDs) prevention interventions, yet, they have high rates of obesity and are at high risk for NCDs, particularly T2DM. The goal of this study was to utilize the local Hispanic community’s interest in soccer as a vehicle to deliver an adapted Diabetes Prevention Program (DPP) among male, overweight, Latino adults at high T2DM risk. Physical activity volume, sleep and sedentary time were tracked objectively with wearable devices linked to an innovative research smartphone app that provided data to the researchers and tailored in-app notifications and surveys to the participants.
A Sleep Intervention (SLEEP-Extend) for Young Adults At-Risk for Type 2 Diabetes
Ashley Coombe, PhD, RN, CNE, Principal Investigator
The risk for developing diabetes in persons with difficulty in maintaining sleep is 1.84 times the risk of diabetes in those who do not have sleep issues which is very similar to the relative risk detected from another commonly recognized risk factor-- family history of diabetes. This study examined whether an intervention to extend sleep would result in behavior change to increase sleep duration and improve insulin resistance, providing evidence of the impacts in intervening with sleep duration to improve metabolic function.
Adoption of New Lifestyles among Refugee Families: Health Implications of Integration
Solveig Cunningham, PhD, Principal Investigator
This project aimed to inform programs to prevent obesity and diabetes among newly arrived people in the U.S. It also provided scientifically and programmatically important information on how health and health behaviors change when people experience a change in their social and economic environments.
Intersection of Chronic Diseases: Understanding the Care Continuum for Patients Co-affected by HIV and Diabetes
Jonathan Colasanti, MD, Principal Investigator
Diabetes among HIV-positive individuals has been emerging as a major comorbidity, fueling cardiovascular and renal disease ultimately resulting in increased morbidity and mortality in this population. To identify gaps in diabetes care, this study aimed to explore the diabetes care continuum among people living with HIV. In addition, this study sought to inform pragmatic interventions to improve regular clinical practice and reduce morbidity in people living with HIV and diabetes.
Translational Potential of Marker of Beta-Cell Death for Prevention of Hyperglycemia Recurrence in Patients with Ketosis-Prone Diabetes
Priyathama Vellanki, MD, MS, Principal Investigator
The investigators will assess cell-free unmethylated insulin DNA levels with insulin secretion (glucagon stimulation tests) at presentation of diabetic ketoacidosis (DKA) and at time of remission or lack thereof. Data generated from the Micro Grant will be used as preliminary data for a R01 that will assess mechanisms of beta-cell death in patients with ketosis-prone diabetes mellitus (KPDM). If correlated with beta-cell function, the translation potential of this marker of beta-cell death can be used as a precision marker to identify which patients will have remission and which patients will have hyperglycemia recurrence and future episodes of ketoacidosis. Future studies will focus on prevention of hyperglycemia recurrence and diabetic ketoacidosis in patients with KPDM.
Everyday Memory and Metacognitive Intervention (EMMI) for Older Adults with Diabetes
Ann Pearman, PhD, Principal Investigator
The PI is currently running a study funded by the Retirement Research Foundation (RRF) examining an everyday memory intervention for recent retirees. The purpose of this micro grant is to add a small group of older adults with Type II diabetes to examine the feasibility and potential benefits of this intervention with them. Given the high cognitive load of diabetes self-management, the intervention is well-suited to help address daily challenges of this population. This micro grant would allow for sufficient pilot testing to (1) determine feasibility of running this project with older adults with diabetes, (2) see where the intervention needs adaptations for this specialized population and to (3) provide preliminary pilot data for an upcoming NIH proposal.
Understanding Gaps in Care and Patient Knowledge for Prevention of Limb Loss in African American Urban Patients with Diabetes
Marcos C. Schechter, MD, Prinicpal Investigator
Diabetes is the leading cause of limb loss in the United States and disproportionately impacts African Americans. Decreasing limb loss rates and racial disparities among people living with diabetes is a CDC Healthy People 2020 priority. Diabetic foot ulcers are often the first recognized sign of impending limb loss. Patient adherence to foot self-care is paramount for ulcer prevention and treatment. Poor foot self-care knowledge and adherence among African Americans has been extensively documented, yet there are no published educational programs aimed at improving foot self-care in this population. The Grady Health System is an urban tertiary health system carrying for a predominantly African American population. Preliminary data indicates there are over 200 amputations per year at Grady. The investigators' clinical experience suggests adherence to foot self-care is low, and patients face numerous challenges to diabetic foot ulcer care leading to presentation with advanced foot disease and high rates of non-salvageable limbs. They will conduct focus group discussions enrolling African American patients with prior or current diabetic foot ulcers or at high risk for diabetic foot ulcers with goal of understanding perception of and adherence to foot protective behaviors in addition to preferred foot education methods in this high-risk population. This data will be used to design a secondary prevention educational program culturally tailored to urban African American populations for future implementation studies.
Effect of Probiotic on Reducing Gastrointestinal Symptoms Related to Metformin Use
Maya Fayfman, MD, Principal Investigator
Metformin is the most widely used antidiabetic agent and is considered first line therapy in the management of type 2 diabetes. Its use, however, is limited by significant gastrointestinal side effects such as diarrhea in approximately 25% of individuals. Metformin is also known to lead to significant alterations in the bacteria that reside in the gut, collectively called the gut microbiome. While some of these changes are beneficial and may contribute to its effects in glucose control, microbiome alterations may also play a role in gastrointestinal adverse effects. In order to study the role of microbiota in metformin intolerance, the PI proposes a cross-sectional study comparing the microbiome of patients with type 2 diabetes with and without a history of metformin intolerance. These findings will serve as preliminary data for an NIH K23 application.